From VA Palo Alto Health Care System, Palo Alto, California; San Francisco VA Medical Center, San Francisco, California; and U.S. Department of Veterans Affairs, Washington, DC.
Ann Intern Med. 2017 Oct 3;167(7):499-504. doi: 10.7326/M17-1073. Epub 2017 Sep 26.
The U.S. Department of Veterans Affairs (VA) is the nation's largest care provider for hepatitis C virus (HCV)-infected patients and is uniquely suited to inform national efforts to eliminate HCV. An extensive array of delivery of services, policy guidance, outreach efforts, and funding has broadened the reach and capacity of the VA to deliver direct-acting antiviral (DAA) HCV therapy, supported by an infrastructure to effectively implement change and informed by extensive population health data analysis. The VA has treated more than 92 000 HCV-infected veterans since all-oral DAAs became available in January 2014, with cure rates exceeding 90%; only 51 000 veterans in VA care are known to remain potentially eligible for treatment. Key actions advancing the VA's aggressive treatment of HCV infection that are germane to non-VA settings include expansion of treatment capacity through the use of nonphysician providers, video telehealth, and electronic technologies; expansion of integrated care to address psychiatric and substance use comorbidities; and electronic data tools for patient tracking and outreach. A critical component of effective implementation has been building infrastructure through the creation of regional multidisciplinary HCV Innovation Teams, whose system redesign efforts have produced innovative HCV practice models addressing gaps in care while providing more efficient and effective HCV management for the populations they serve. Financing for HCV treatment and infrastructure resources coupled with reduced drug prices has been paramount to the VA's success in curing HCV infection. The VA is poised to share and extend best practices to other health care organizations and providers delivering HCV care, contributing to a concerted effort to reduce the overall burden of HCV infection.
美国退伍军人事务部（VA）是该国感染丙型肝炎病毒（HCV）患者的最大护理提供者，非常适合为消除 HCV 提供国家努力的信息。广泛的服务提供、政策指导、外展工作和资金投入拓宽了 VA 提供直接作用抗病毒（DAA）HCV 治疗的范围和能力，得到了有效实施变革的基础设施和广泛的人口健康数据分析的支持。自 2014 年 1 月所有口服 DAA 可用以来，VA 已治疗了超过 92000 名 HCV 感染的退伍军人，治愈率超过 90%；只有 51000 名在 VA 护理中的退伍军人被认为仍有可能有资格接受治疗。推进 VA 积极治疗 HCV 感染的关键行动与非 VA 环境相关，包括通过使用非医师提供者、视频远程医疗和电子技术扩大治疗能力；扩大综合护理以解决精神和物质使用合并症；以及用于患者跟踪和外展的电子数据工具。有效实施的一个关键组成部分是通过创建区域多学科 HCV 创新团队来建立基础设施，其系统重新设计工作产生了创新的 HCV 实践模型，解决了护理差距，同时为他们所服务的人群提供了更高效和有效的 HCV 管理。HCV 治疗和基础设施资源的融资以及降低药品价格对 VA 成功治愈 HCV 感染至关重要。VA 准备与提供 HCV 护理的其他医疗保健组织和提供者分享和扩展最佳实践，为减少 HCV 感染的整体负担做出贡献。
